Gina Dattilo PsyD/Forward Focus Therapy LLC

United States
(484) 558-0343


This notice describes how protected health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Privacy is a very important concern for all those who come to this office and who work here. It is also complicated, because of the many federal and state laws and our professional ethics. We are required to abide by the terms of our Notice of Privacy Practices currently in effect. Each time you visit us a health care provider, information is collected about you and your physical and mental health. It may be information about your past, present, or future health or conditions, or the tests or treatment you got from us or from others, or about payment for health care. All this information is called “PHI,” which stands for “protected health information” which means its privacy must be protected. This information goes into your medical or health care records. Protected health information may be information about health care we provide to you. If you have any questions, your therapist will be happy to help you understand our procedures and your rights. When you understand what is in your record and what it is used for, you can make better decisions about what other persons or agencies should have this information, when, and why.


How we use and disclose your protected health information (PHI) with your consent

We will use the information we collect about you mainly to provide you with treatment; to arrange payment for our services; and for some other business activities called, in the law, “health care operations.” We will ask you to sign a separate consent form to show that you understand these ways we handle your information. If you do not agree and won’t sign this consent form, we will not treat you. If we want to use or send, share, or release your PHI for other purposes, we will discuss this with you so you fully understand it, and ask you to sign a release-of-information form to allow this.


Your Rights

When it comes to your health information, you have certain rights. (let us know if you need help with any of them)


Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. 

We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

You also have a right to have a copy of this notice


Ask to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 days.


Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.


Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations.

We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.

We will say “yes” unless a law requires us to share that information.


Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.


Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.


Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

We will make sure the person has this authority and can act for you before we take any action.


File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us 64 East Uwchlan Ave Suite 110, Exton PA 19341 //  You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting

 We will not retaliate against you for filing a complaint.


Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, tell us what you want us to do, & we will follow your instructions.


In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care

Share information in a disaster relief situation

Include your information in a hospital directory

Contact you for fundraising efforts

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.


In these cases we never share your information unless you give us written permission

Marketing purposes, sale of your information & most sharing of psychotherapy notes


In the case of fundraising

We may contact you for fundraising efforts, but you can tell us not to contact you again.


Uses & Disclosure

We typically share information in the following ways:


Treat you

We can use your health information and share it with other professionals who are treating you.


Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary



We can use and share your health information to bill and get payment from health plans or other entities.


We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:


Help with public health and safety

We can share health information about you for certain situations such as: • Preventing disease• Helping with product recalls• Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence• Preventing or reducing a serious threat to anyone’s health or safety


Research We can use or share your information for health research.


Comply with laws We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.


Respond to organ and tissue donation and requests

We can share health information about you with organ procurement organizations.


Work with medical examiner/funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.


Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims

For law enforcement purposes or with a law enforcement official

With health oversight agencies for activities authorized by law

For special government functions such as military, national security, and presidential protective services


Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.


Our Responsibilities


We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: to the Terms of This Notice.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.


This Notice of Privacy Practices applies to the following organizations.

All providers, contractors and employees


The effective date of this notice is 09/27/2020

If you are in an immediate crisis, please call 911 in the US and Canada, 999 in the UK, 000 In Australia or 112 in Europe.
Alternatively, you can visit Befrienders Worldwide to find a suicide helpline for your country.

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